LARYNGOLOGY Possible implication of Mdm2 as a prognostic marker in invasive laryngeal carcinoma Marcela K. Hassumi-Fukasawa • Fabiana A. Miranda-Camargo • Ma ´rcia C. M. Guimara ˜es • Renata T. Simo ˜es • Eduardo A. Donadi • Christiane P. Soares • Edson G. Soares Received: 10 August 2011 / Accepted: 16 January 2012 / Published online: 5 February 2012 Ó Springer-Verlag 2012 Abstract Laryngeal squamous cell carcinoma is one of the most common malignant neoplasms of the head and neck. In Brazil, laryngeal tumors represent 2% of all can- cers and are associated with approximately 3,000 deaths annually. Human papillomavirus (HPV) has been reported to play an important role in the etiology of laryngeal cancer. The aim of the present study was to evaluate the expression of p53, p27, and Mdm2 in laryngeal carcinomas. Sixty-three larynx biopsies were selected for the study, including 9 in situ laryngeal carcinomas, 27 laryngeal carcinomas without metastasis and 27 laryngeal carcinomas with metastasis. Twenty-seven cervical lymph nodes from patients with metastatic lesions were also evaluated. The expression levels of p53, p27, and Mdm2 were assessed by immuno- histochemistry using a computer-assisted system. HPV detection and typing were performed using PCR, and the HPV types that were evaluated included HPV 6, 11, 16, 18, 31 and 33. Out of 63 patients, 53 (84.1%) were positive for b-globin (internal control), and 10 (15.9%) were b-globin negative and therefore excluded from the evaluation. Thus, 7 (13.2%) out of 53 patients were HPV positive, and 46 (86.8%) out of 53 patients were HPV negative. Statistically significant differences (p \ 0.05) in Mdm2 expression levels were observed in the in situ laryngeal carcinoma samples compared with the laryngeal carcinoma samples with metastasis. No statistically significant differences (p [ 0.05) in either p53 or p27 expression levels were detected. These findings suggest that Mdm2 may be asso- ciated with the invasiveness and aggressiveness of laryngeal carcinomas. Keywords Squamous cell carcinoma Á Larynx Á HPV Á p53 Á p27 Á Mdm2 Introduction Laryngeal squamous cell carcinoma (LSCC) is one of the most common malignant neoplasms of the head and neck and represents 2.8% of the new cancer cases occurring in males worldwide [59]. In Brazil, approximately 8,000 new cases of malignant laryngeal lesions are diagnosed each year [68]. Smoking and alcohol consumption are the most powerful risk factors for the development of LSCC [7, 25, 48]. Epi- demiological evidence has demonstrated that, in addition to tobacco and alcohol use, human papillomavirus (HPV) is a causative agent for some head and neck squamous cell carcinomas (HNSCC), including LSCC [43, 60, 64]. The biology of various neoplasms has been investigated using a wide range of techniques, such as immunohisto- chemistry [22]. These studies have revealed that alterations in certain genes and the expression of proteins that they M. K. Hassumi-Fukasawa (&) Á F. A. Miranda-Camargo Á M. C. M. Guimara ˜es Á E. G. Soares Department of Pathology, Faculty of Medicine of Ribeira ˜o Preto, University of Sa ˜o Paulo, Avenida dos Bandeirantes, 3900, 14049-900 Ribeira ˜o Preto, SP, Brazil e-mail: marcelahassumi@usp.br R. T. Simo ˜es Post Graduation and Research Nucleus, Hospital Santa Casa de Belo Horizonte, Belo Horizonte, MG, Brazil E. A. Donadi Division of Clinical Immunology, Department of Medicine, Faculty of Medicine of Ribeira ˜o Preto, University of Sa ˜o Paulo, Sa ˜o Paulo, SP, Brazil C. P. Soares Department of Clinical Analysis, School of Pharmaceutical Sciences, UNESP, Sa ˜o Paulo, SP, Brazil 123 Eur Arch Otorhinolaryngol (2012) 269:1795–1804 DOI 10.1007/s00405-012-1937-3